Gold Star Community Health Center, Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · N Hollywood, CA
NPI 1124696349 · NPPES record last updated Jun 14, 2021
Key facts
- NPI
- 1124696349
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- GOLD STAR COMMUNITY HEALTH CENTER, INC.
- Practice address
- 6343 Vineland Ave
N Hollywood, CA 91606-3721 - Phone
- (747) 877-2789
- NPI assigned
- Jun 14, 2021
- Organization subpart
- No
Authorized official
- Name
- Ella Undzhyan
- Title
- Ceo
- Phone
- (747) 877-2788
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2263969 | Gold Star Community Health Center, Inc. | Certificate of waiver | Jul 6, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210726003002 | CA | Part a Provider - Community Mental Health Center | 3870996077 | Practice locations: N Hollywood, CA |
National Provider Directory
Locations
6343 Vineland Ave
North Hollywood, CA 91606
Phone (747) 877-2788
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
6343 Vineland Ave
N Hollywood, CA 91606-3721
Mailing address
6343 Vineland Ave
N Hollywood, CA 91606-3721
Phone (747) 877-2789
Other providers in N Hollywood, CA
- Four Seasons Health
- Kari French
- Laurie Lynne Garza
- Gateway la Inc
- Allan Gerson
- Stephanie Gordillo-Gomez
- Happy Venue Adhc Inc
- HB Gutstein & Co
- Heal Medical Clinic Inc
- Health Network Laboratories
All providers in N Hollywood, CA · Mental Health Clinic/Center (Including Community Mental Health Center) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.